Transcript Descriptive Epidemiology - Virginia Institute for

Descriptive Epidemiology and Cancer
Prevention and Control
Resa M. Jones, M.P.H., Ph.D.
Special Topic: Cancer Control
January 23, 2006
[email protected]
Learning Objectives
 Students should be able to:









Explain the impact of cancer internationally and nationally
Identify the most prevalent cancers internationally and nationally
Identify the leading causes of cancer death internationally and nationally
Explain the difference in cancer incidence and death rates by gender, age,
and race/ethnicity
Identify the relationship between cancer control and disease frequency
measures
Explain the historical perspective of cancer control
Understand the cancer control continuum and explain its implication to
public health
Identify the differences between clinical and intervention studies
Explain important factors and trends affecting cancer control and directions
for future research
What is cancer?
 Cancer is a group of diseases characterized
by uncontrolled growth and spread of
abnormal cells.
 Cancer is caused by external factors and
internal factors which may act together to
initiate or promote carcinogenesis.
Biologic Basis for Cancer Control
Progression
Initiation
Promotion
Normal
Initiated
Pre-cancerous
CANCER
cell
cell
cell
Rates
 Incidence
 Prevalence
 Specific
 Crude
 Adjusted/Standardized
 SMR/SIR
Cancer incidence for the regions of
the world, 2002 estimates
Age standardized incidence rates for all cancers*
by region of the world, 2002 estimates
The most commonly diagnosed cancers*
worldwide, 2002 estimates
Trends in the numbers of new cases being
diagnosed worldwide, selected cancers,
1975-2000
The proportion of all deaths caused by cancer in
the different regions of the world, 2002
The most common causes of death from
cancer* worldwide, 2002 estimates
Surveillance
Mortality: Leading Causes of Death
Rank
Cause of Death
No. of
deaths
% of all
deaths
1.
Heart Diseases
696,947 28.5
2.
Cancer
557,271 22.8
3.
Cerebrovascular diseases
162,672
6.7
4.
Chronic lower respiratory diseases
124,816
5.1
5.
Accidents (Unintentional injuries)
106,742
4.4
6.
Diabetes mellitus
73,249
3.0
7.
Influenza and pneumonia
65,681
2.7
8.
Alzheimer disease
58,866
2.4
9.
Nephritis
40,974
1.7
10.
Septicemia
33,865
1.4
Source: US Mortality Public Use Data Tape 2002, National Center for Health Statistics, Centers for Disease Control
and Prevention, 2004.
Change in the US Death Rates* by
Cause, 1950 & 2001
600
500
1950
586.8
2001
Rate Per 100,000
400
300
Heart
Diseases
245.8
200
Cerebrovascular
Diseases
Cancer
193.9
180.7
Pneumonia/
Influenza
100
57.5
48.1
21.8
0
* Age-adjusted to 2000 US standard population.
Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.
2001 Mortality Data–NVSR-Death Final Data 2001–Volume 52, No. 3.
http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_03.pdf
194.4
Estimated New Cancer Cases
Prostate
33%
Lung and bronchus
Colon and rectum
Men
710,040
Women
662,870
32%
Breast
13%
12%
Lung and bronchus
10%
11%Colon and rectum
Urinary bladder
7%
6%
Uterine corpus
Melanoma of skin
5%
4%
Non-Hodgkin
lymphoma
4%
Non-Hodgkin
lymphoma
4%
Kidney
3%
Melanoma
of skin
Leukemia
3%
3%
Ovary
Oral Cavity
3%
3%
Thyroid
Pancreas
2%
2%
Urinary bladder
17%
2%
Pancreas
All Other Sites
21%
All Other Sites
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Source: American Cancer Society, 2005.
Estimated New Cancer Cases and Survival
Five-year relative survival rates1 (percent)
Estimated new cases, 2005
White
Black
All races
Total
Male
Female
1983–
1985
1992–
1998
1983–
1985
1992–
1998
1983–
1985
1992–
1998
1,372,910
710,040
662,870
54%
64%
40%
53%
52%
62%
Lung
172,570
93,010
79,500
14
15
11
12
14
15
Breast3
212,930
1,690
211,240
79
88
63
73
78
86
Colon
104,950
48,290
56,660
58
63
49
53
58
62
Rectum
40,340
23,530
16,810
56
62
44
53
55
62
Prostate
232,090
232,090
n.a.
76
98
64
93
75
97
Bladder
63,210
47,010
16,200
78
82
60
65
78
82
Uterine corpus
36,160
22,490
13,670
85
86
54
61
83
84
Non-Hodgkins lymphoma4
56,390
29,070
27,320
54
56
45
46
54
55
Oral cavity and pharynx
29,370
19,100
10,270
55
59
35
35
53
56
Leukemia4
34,810
19,640
15,170
42
47
34
38
41
46
Melanoma—skin
59,580
33,580
26,000
85
89
74
66
85
89
Pancreas
32,180
16,100
16,080
3
4
5
4
3
4
Kidney
36,160
22,490
13,670
56
62
55
60
56
62
Stomach
21,860
13,510
8,350
16
21
19
20
17
22
Ovary
22,220
n.a.
22,220
40
53
42
53
41
53
Uterine cervix
10,370
n.a.
10,370
71
72
60
60
69
71
Site
All sites2
NOTE: n.a. = not applicable.
1. The 5-year relative survival rate indicates that a person will not die from causes directly related to their cancer within 5 years.
2. Includes other sites not shown separately.
3. Survival rates for females only.
4. All types combined.
Source: U.S. National Institutes of Health, National Cancer Institute.
Cancer Incidence Rates* for
Women, US, 1975-2001
250
Rate Per 100,000
200
150
Breast
100
Colon & rectum
50
Lung & bronchus
Uterine corpus
2001
1999
1997
1995
1993
1991
1989
1987
1985
1983
1981
1979
1977
0
1975
Ovary
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2004.
Cancer Incidence Rates* for Men,
US, 1975-2001
Rate Per 100,000
250
Prostate
200
150
Lung & bronchus
100
Colon & rectum
50
Urinary bladder
2001
1999
1997
1995
1993
1991
1989
1987
1985
1983
1981
1979
1977
0
1975
Non-Hodgkin lymphoma
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2004.
Estimated Cancer Deaths
Lung and bronchus
31%
Prostate
10%
Colon and rectum
Men
295,280
Women
275,000
27%
Lung and bronchus
15%
Breast
10%
10%
Colon and rectum
Pancreas
5%
6%
Ovary
Leukemia
4%
6%
Pancreas
Esophagus
4%
4%
Leukemia
Liver and intrahepatic
bile duct
3%
3%
Non-Hodgkin
lymphoma
Non-Hodgkin
Lymphoma
3%
3%
Uterine corpus
Urinary bladder
3%
2%
Multiple myeloma
Kidney
3%
2%
Brain/ONS
All other sites
24%
ONS=Other nervous system.
Source: American Cancer Society, 2005.
22%
All other sites
Cancer Death Rates*, for
Women, US,1930-2001
100
Rate Per 100,000
80
60
Lung & bronchus
40
Uterus
Breast
Colon & rectum
Stomach
20
Ovary
*Age-adjusted to the 2000 US standard population.
Source: US Mortality Public Use Data Tapes 1960-2001, US Mortality Volumes 1930-1959,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
1950
1945
1940
1935
Pancreas
1930
0
Cancer Death Rates*, for Men,
US,1930-2001
100 Rate Per 100,000
Lung & bronchus
80
60
Stomach
Prostate
40
Colon & rectum
20
Pancreas
*Age-adjusted to the 2000 US standard population.
Source: US Mortality Public Use Data Tapes 1960-2001, US Mortality Volumes 1930-1959,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.
2000
1995
1990
1985
1980
1975
1970
1965
1960
Liver
1955
1950
1945
1940
1935
Leukemia
1930
0
Cancer Incidence Rates* by Sex and Race,
All Sites, 1975-2001
900
Rate Per 100,000
800
700
African American men
600
White men
500
White women
400
African American women
300
200
2001
1999
1997
1995
1993
1991
1989
1987
1985
1983
1981
1979
1977
0
1975
100
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2004.
SEER Age Adjusted Incidence Rates by Race
All Cancer Sites, All Ages
SEER 9 Registries for 1973-2002
SEER Age Adjusted Incidence Rates by Sex
All Cancer Sites, All Ages
SEER 9 Registries for 1973-2002
Cancer Incidence Rates* by Race and
Ethnicity, 1997-2001
Rate Per 100,000
800
Men
689.2
700
600
500
Women
556.5
429.8
400.1
400
419.8
385.9
309.9
302.8
300
263.2
222.5
200
100
0
White
African American
Asian/Pacific Islander
American Indian/
Alaskan Native
Hispanic†
*Age-adjusted to the 2000 US standard population.
†Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2004.
Cancer Death Rates* by Sex and Race,
US, 1975-2001
Rate Per 100,000
500
450
African American men
400
350
300
White men
250
African American women
200
White women
150
100
2001
1999
1997
1995
1993
1991
1989
1987
1985
1983
1981
1979
1977
0
1975
50
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2004.
Age-Adjusted Total US Mortality Rates
All Cancer Sites, All Ages
For 1992-2002 by 'Expanded' Race and Sex
Cancer Sites in Which African-American Death Rates*
Exceed White Death Rates* for Men, US, 1996-2000
Site
•All sites
•Larynx
•Prostate
•Stomach
•Myeloma
•Oral cavity and pharynx
•Esophagus
•Liver
•Lung & bronchus
•Pancreas
•Small intestine
•Colon & rectum
African
American
356.2
5.7
73.0
14.0
9.2
7.9
12.2
9.3
107.0
16.4
0.7
34.6
White
249.5
2.4
30.2
6.1
4.5
4.0
7.3
6.0
78.1
12.0
0.5
25.3
Ratio of African
American/White
1.4
2.4
2.4
2.3
2.0
2.0
1.7
1.6
1.4
1.4
1.4
1.4
*Per 100,000, age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control
and Population Sciences, National Cancer Institute, 2003.
Cancer Sites in Which African-American Death Rates*
Exceed White Death Rates* for Women, US, 1996-2000
African American
•All sites
•Myeloma
•Stomach
•Uterine cervix
•Esophagus
•Uterine corpus, NOS
•Larynx
•Liver & intrahepatic bile duct
•Pancreas
•Colon & rectum
•Breast
•Urinary bladder
•Soft tissue, including heart
198.6
6.6
6.5
5.9
3.4
7.0
0.9
3.0
12.9
24.6
35.9
3.0
1.7
White
166.9
2.9
2.9
2.7
1.7
3.8
0.5
1.9
8.9
17.5
27.2
2.3
1.3
Ratio of African
American/White
1.2
2.3
2.2
2.2
2.0
1.8
1.8
1.6
1.5
1.4
1.3
1.3
1.3
*Per 100,000, age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control
and Population Sciences, National Cancer Institute, 2003.
Lifetime Probability of Developing
Cancer,
By Site, Men, US, 1999-2001
Site
All sites
Prostate
Risk
1 in 2
1 in 6
Lung and bronchus
1 in 13
Colon and rectum
1 in 17
Urinary bladder
1 in 28
Non-Hodgkin lymphoma
1 in 46
Melanoma
1 in 53
Kidney
1 in 67
Leukemia
1 in 68
Oral Cavity
1 in 73
Stomach
1 in 81
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 5.2 Statistical Research and
Applications Branch, NCI, 2004. http://srab.cancer.gov/devcan
Lifetime Probability of Developing
Cancer,
By Site, Women, US, 1999-2001
Site
Risk
All sites
Breast
1 in 3
1 in 7
Lung & bronchus
1 in 18
Colon & rectum
1 in 18
Uterine corpus
1 in 38
Non-Hodgkin lymphoma
1 in 56
Ovary
1 in 68
Melanoma
1 in 78
Pancreas
1 in 81
Urinary bladder
1 in 88
Uterine cervix
1 in 130
Source:DevCan: Probability of Developing or Dying of Cancer Software, Version 5.2 Statistical Research and
Applications Branch, NCI, 2004. http://srab.cancer.gov/devcan
Cancer Survival*(%) by Site and
Race,1995-2000
Site
White
African
American
Difference
All Sites
66
55
11
Breast (female)
89
75
14
Colon
64
54
10
Esophagus
16
9
7
Leukemia
48
39
9
Non-Hodgkin lymphoma
60
51
9
Oral cavity
61
39
22
Prostate
100
96
4
Rectum
65
55
10
Urinary bladder
83
62
21
Uterine cervix
74
66
8
Uterine corpus
86
63
23
*5-year relative survival rates based on cancer patients diagnosed from 1995 to 2000 and followed through 2001.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2004.
Cancer Incidence & Death Rates* in
Children 0-14 Years, 1975-2000
18
Rate Per 100,000
16
Incidence
14
12
10
8
6
Mortality
4
2
0
1975
1980
1985
1990
1995
2000
*Age-adjusted to the 2000 Standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences,
National Cancer Institute, 2003.
Annual Incidence per Million
Yearly Incidence of Common
Childhood Cancers
35
30
25
20
15
10
5
0
S
B
R
S
L
M
R
M
A
T
D
H
W
L
H
N
S
B
N
T
B
LL
A
Cancer Incidence Rates* in Children 014 Years, by Site, US, 1996-2000
Site
Male
All sites
15.4
13.8
14.6
4.9
4.1
4.5
3.9
3.3
3.6
Brain/ONS
3.3
2.9
3.1
Non-Hodgkin lymphoma
1.2
0.4
0.8
Kidney & Renal pelvis
0.9
1.0
0.9
Soft tissue
1.0
1.1
1.0
Bones & Joint
0.8
0.5
0.6
Hodgkin’s disease
0.6
0.6
0.6
Leukemia
Acute Lymphocytic
Female Total
* Per 100,000, age-adjusted to the 2000 US standard population.
ONS = Other nervous system
Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2003
Cancer Death Rates* in Children 0-14
Years, by Site, 1996-2000
Site
Male
Female Total
All sites
2.8
2.3
2.5
Leukemia
0.9
0.7
0.8
0.4
0.3
0.4
Brain/ONS
0.8
0.7
0.7
Non-Hodgkin lymphoma
0.1
0.1
0.1
Soft tissue
0.1
0.1
0.1
Bones & Joint
0.1
0.1
0.1
Kidney & Renal pelvis
0.1
0.1
0.1
Acute Lymphocytic
* Per 100,000, age-adjusted to the 2000 US standard population.
ONS = Other nervous system
Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2003.
Trends in Survival, Children 0-14 Years,
All Sites Combined, 1974-1999
Age
0 - 4 Years
Year of
Diagnosis 5 - Year Relative Survival Rates *
1974 - 76
56.5
1992 - 99
5 - 9 Years
1974 - 76
77.3
55.3
1992 - 99
1974 - 76
77.6
55.2
10 - 14 Years
1992- 99
*5-year relative survival rates, based on follow up of patients through 2000.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2003.
77.6
Lung Cancer
 Risk factors

Cigarette smoking, environmental exposures,
tuberculosis
 Detection/Prevention

Reduce exposure to tobacco smoke
Breast Cancer
 Risk Factors

Age, family history, biopsy, breast density, early
menstruation, obesity after menopause, recent
use of oral contraceptives, hormone therapy, late
or no children, alcohol, breast feeding, exercise
 Early Detection

Mammography and clinical breast exam every
year after age 40 (ACS)
Prostate Cancer
 Risk factors

Age, ethnicity, family history, dietary fat?,
weight?
 Early detection/prevention >50yrs old


PSA blood test/yr
Digital rectal exam/yr
Colorectal Cancer
 Risk factors

Age, family history, smoking , alcohol, obesity, exercise,
high fat diet/red meat
 Early Detection/Prevention

4 modalities recommended for people age 50 and older




Fecal occult blood test (FOBT) every year
Flexible sigmoidoscopy every 5 years
Colonoscopy every 10 years
Double-contrast barium enema every 5 years
Cancer control:
Historical perspective
 1913


American Society for the Control of Cancer (became American
Cancer Society in 1945)
American College of Surgeons formed (Developed standards for
cancer clinics in 1930)
 1937

National Cancer Institute formed “[to] prompt use of most effective
methods of prevention, diagnosis and treatment of cancer”
Cancer control:
Historical perspective
 1971

National Cancer Act Cancer centers responsible for conducting
cancer demonstration and outreach programs
 1974

Division of cancer prevention and control (DCPC) formed at NCI
 1983

Cancer control defined
 Clinical Community Oncology Programs (CCOP)
 Clinical Cooperative Group Trials
Cancer control:
Historical perspective
 1997

DCPC at NCI splits into two divisions:


Cancer Prevention
Cancer Control and Population Science
 1998/1999

New Strategy, new definition, new model
Definition: Cancer control
 …the reduction of cancer incidence, morbidity, and
mortality through an orderly sequence from research on
interventions and their impact in defined populations to the
broad systematic application of the research results. (Old)
 …the conduct of basic and applied research in the
behavioral, social, health and population sciences to create
or enhance interventions that, independently or in
combination with biomedical approaches, reduce cancer
risk, incidence, morbidity and mortality, and improve quality
of life (Cancer Control Review Group, 1998 - modified).
Intervention Research
Fundamental
Research
Knowledge
synthesis
Surveillance
Research
Application and Program Delivery
Reducing the cancer
burden
Fig. 1 Cancer control research activities. Adapted from the 1994 Advisory Committee
on Cancer Control, National Cancer Institute of Canada (61).
What is cancer control research?
 Research that aims to reduce risk, incidence, and deaths from cancer as
well as enhance the quality of life for cancer survivors.

The DCCPS conducts and supports an integrated program of the
highest quality genetic, epidemiologic, behavioral, social, applied,
and surveillance cancer research. Cancer control research aims to
understand the causes and distribution of cancer in populations,
support the development and implementation of effective
interventions, and monitor and explain cancer trends in all segments
of the population. Central to these activities is the process of
synthesis and decision-making that aids in evaluating what has been
learned, identifying new priorities and strategies, and effectively
applying research discoveries to reduce the cancer burden.
How much cancer incidence and
mortality can we prevent by 2015?
Incidence
American Cancer Society challenge goal
If trends (1980-95) for risk factors continue
If trends (1980-95) for risk factors are accelerated
Mortality
25%
50%
13 %
21%
19%
29%
Comprehensive Cancer Control
Plans
 Basic Implementation:

28 States/Territories/Republics
 Capacity Building:

33 States/Territories/Republics
 Not Yet Funded:

3 States/Territories
Prevention
 Primary
 Secondary
 Tertiary
 Terms




Mortality
Morbidity
Incidence
Prevalence
Percent of cancer that could be
prevented if risk factor were removed
Risk factors
Lung
Colorectal Breast
Prostate
Tobacco
Diet
Physical inactivity
78
19
---
--29
19
----7
--9
---
Obesity
Alcohol
Non-use of
Antiestrogens
Failure to screen
-------
29
-----
38
5
29
-------
---
34
6
---
Byers, et al, Cancer 1999; 86: 715-727; * not in original report
Strategies for cancer prevention
Level of intervention
Examples
Individual
Group nutrition programs
Smoking cessation programs
Physician’s advice
Interpersonal
Physician’s advice
Organizational
Worksite cafeteria menu
Health care benefit policies
Restaurant smoking bans
Mass media
Societal
Tobacco control legislation
Engineering the environment
IOM, fulfilling the potential of cancer prevention and early detection, 2003
5000
100
4500
90
4000
80
Per capita cigarette consumption
3500
70
3000
60
Male lung cancer death rate
2500
50
2000
40
1500
30
1000
20
Female lung cancer death rate
500
10
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
1950
1945
1940
1935
1930
1925
1920
1915
1910
1905
0
1900
0
Age-Adjusted Lung Cancer Death
Rates*
Per Capita Cigarette Consumption
Tobacco Use in the US, 1900-2000
Year
*Age-adjusted to 2000 US standard population.
Source: Death rates: US Mortality Public Use Tapes, 1960-2000, US Mortality Volumes, 1930-1959, National
Center for Health Statistics, Centers for Disease Control and Prevention, 2002. Cigarette consumption: US
Department of Agriculture, 1900-2000.
Trends in Cigarette Smoking Prevalence* (%),
by Gender, Adults 18 and Older, US, 1965-2001
60
40
Men
30
20
Women
10
2001
2000
1999
1998
1997
1995
1994
1992
1990
1985
1983
1979
1974
0
1965
Prevalence (%)
50
Year
*Redesign of survey in 1997 may affect trends.
Source: National Health Interview Survey, 1965-2001, National Center for Health Statistics, Centers for Disease
Control and Prevention, 2003.
Trends in per capita cigarette consumption for selected states
and the average consumption across all states, 1980-2001
140
Per Capita Sales (# of Packs)
120
United States
100
Massachusetts
80
60
California
40
20
0
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
Year
Data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2001: impact and
opportunity, Volume 36. Arlington (VA): Orzechowski and Walker; 2001. Reprinted with permission. Source: Weir
et al. Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for
cancer prevention and control. J Natl Cancer Inst 2003; 95:1276-1299
Current* Cigarette Smoking Prevalence (%), by Gender
and Race/Ethnicity, High School Students, US, 1991-2001
50
40 40
Prevalence (%)
40
32
1991
40
39
37
1995
1997
30
2001
38
33
31
1999
35 36 34
33 32 32
30
28 28
26
17
11 12
18
27
23
22
20
28
16
13
14
10
0
White, nonHispanic
Female
White, nonHispanic Male
African
African
American, non- American, nonHispanic
Hispanic Male
Female
Hispanic
Female
Hispanic Male
*Smoked cigarettes on one or more of the 30 days preceding the survey.
Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002.
Trends in Consumption of Five or More Recommended
Vegetable and Fruit Servings for Cancer Prevention,
Adults 18 and Older, US, 1994-2002
35
Prevalence (%)
30
25
24.2
24.4
24.1
24.4
24.5
1994
1996
1998
2000
2002
20
15
10
5
0
Year
Note: Data from participating states and the District of Columbia were aggregated to represent the United
States.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape
(2000), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and
Prevention, 1997, 1999, 2000, 2001.
Trends in Leisure-Time Physical Activity Prevalence (%), by
Educational Attainment, Adults 18 and Older, US, 1992-2002
60
55
50
45
40
35
30
25
20
15
10
5
0
2002
2000
1998
1996
1994
All adults
1992
Prevalence (%)
Adults with less than a high school education
Year
Note: Data from participating states and the District of Columbia were aggregated to represent the United
States. Educational attainment is for adults 25 and older.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape
(2000), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and
Prevention, 1997, 1999, 2000, 2001.
Trends in Overweight* Prevalence, Children and
Adolescents, by Age Group (%), US, 1971-2000
20
15
Prevalence (%)
15
11
11
10
10
7
5
7
6
5
5
4
5
5
0
2 to 5 years
NHANES I (1971-74)
6 to 11 years
NHANES II (1976-80)
12 to 19 years
NHANES III (1988-94)
NHANES 1999-2000
*Overweight is defined as at or above the 95th percentile for body mass index by age and sex based on
reference data.
Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey,
1971-1974, 1976-1980, 1988-1994, 1999-2000, National Center for Health Statistics, Centers for Disease Control
and Prevention, 2002.
Trends in Obesity* Prevalence (%), By
Gender, Adults Aged 20 to 74, US, 1960-2000
45
40
34
Prevalence (%)
35
31
30
28
26
23
25
21
20
15
13
17
16 17
15 15
11
12 13
10
5
0
Both sexes
Men
NHES I (1960-62)
NHANES I (1971-74)
NHANES III (1988-94)
NHANES 1999-2000
Women
NHANES II (1976-80)
*Obesity is defined as a body mass index of 30 kg/m2 or greater. Source: National Health Examination Survey
1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2000,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2002.
Important trends affecting cancer
control
Aging population
Diverse population
Revolution in communication and informatics
Discovery in molecular biology and genetics
Changes in health care delivery
Cancer control research directions for
the 21st century
Basic research of behavioral, social & biological mechanisms
Informatics and communication
Prevention across the lifespan (modifiable risk factors)
Cancer screening
Health care delivery systems
Survivorship
Underserved populations
Methods research
Genetic predisposition and gene-environment interaction
Chemoprevention
Conferences
 American Society of Preventive Oncology
 American Society of Clinical Oncology
 American Association for Cancer Research